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Richard I. Ecker, M.D. Certified by American Board of Dermatology Physician and Surgeon
Diplomate American Board of Dermatology
Dermatology Dermatologic Surgery MOHS Surgery
Offices: (Click office for directions) 706 N.E. Evans McMinnville, Oregon 97128 (503) 472-1405 Toll Free (866) 661-0319
Fax: (503) 434-5950 310 N. Villa Road Suite 106 Newberg, Oregon 97132 (503) 538-0668
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Scars are the result of the skin's repair of wounds caused by accident, disease, or surgery. This is a natural part of the healing process. The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar.
Before and after treatment of acne scarring.
Typically, a scar will become more prominent at first, then gradually fade. Many actively healing scars which seem unsightly at three months may heal quite satisfactorily if given more time.
A scar's appearance will depend on its color, texture, depth, length, width or location. How the scar forms will also be affected by an individual's age and location on the body or face. Younger skin makes strong repairs and tends to overheal, resulting in larger, thicker scars than on older skin. Skin over a jawbone is tighter than skin on the cheek and will make a scar easier to see. If a scar is depressed, it will make skin seem shaded, and if it is higher than surrounding skin, it will cast a shadow. A scar that crosses natural expression lines will be more apparent because it will not follow a natural pattern, and a scar that is wider than a wrinkle will stand out because it is not a naturally occurring line.
Any one, or a combination, of these factors may result in a scar that, although healthy, may be improved by treatment.
What Can and Cannot Be Done for Scars Several techniques can minimize a scar. Most of these are done routinely in the dermatologist's office with local anesthesia. Only severe scars, such as burns over a large part of the body, require general anesthesia and a hospital stay.
Surgical scar revision can change the length, width, or direction of a scar; raise depressed scars, or lower elevated scars. However, no scar can ever be completely erased; and no magic technique will return skin to its uninjured appearance. Surgical scar revision can provide improvement in the appearance of the skin, while leaving another-though less obvious-mark. In addition, a scar's color cannot be altered; as it gets older, it usually fades and can often be hidden with make-up, but a certain difference in pigmentation will usually remain.
The most important step in the treatment of scars is careful consultation between patient and dermatologist-finding out what bothers a patient most about a scar and deciding the best treatment. Physicians stress that each scar is different, and each requires a different approach.
Scar Treatment
Surgical Scar Revision. The surgical removal of scars is best suited to wide or long scars, those in prominent places, or scars that have healed in a particular pattern or shape. Based on the ability of the skin to stretch with time, surgical scar revision is a method of removing a scar and rejoining the normal skin in a less conspicuous fashion. Wide scars can often be cut away and closed, resulting in a narrower, less obvious scar, and long scars can be shortened. Dermatological surgeons may use a technique of irregular or staggered incision lines, rather than straight-line incisions, to form a broken-line scar which is much more difficult to recognize. Sometimes, a scar's direction can be changed so that all or part of the scar that crosses a natural wrinkle or line falls into the wrinkle, making it less noticeable. This method can also be used to move scars into more favorable locations, such as into a hairline, or a natural junction (for instance, where the nose meets the cheek.)
Best results are obtained when the scar is removed and wound edges are brought together without tension. Accordingly, scar removal is planned with great care for the details of the muscle layers.
Result of early dermabrasion scar treatment.
Dermabrasion, is a method of treating fine scars or minor irregularities of surface skin, and improving the look of some surgical scars or acne scars. An electrical machine is used to remove the top layers of skin. Dermabrasion levels out irregularities in the contour of the skin and may offer improvement for certain scars, although it cannot get rid of the scar. Dermabrasion has been used with favorable results on acne scars, chickenpox scars, tattoos, wrinkle lines, and surgical scars. Patients can usually return to work within two to three weeks; some patients can return to work after only one week. If defects are minor, only one dermabrasion will be needed. Several abrasions may be required if defects are deep and extensive, as in deep acne scars.
Laser Resurfacing Another method of treating fine scars and wrinkles is laser resurfacing. High energy light is used to burn away unwanted, damaged skin. Patients can return to work within two weeks, but discoloration of the skin can last three to six months. Several types of lasers are available depending on the skin defect requiring improvement.
Collagen Injections Injectable collagen, a natural animal protein, is a substance used to raise sunken soft, scars. The amount of collagen injected will vary with the size and firmness of the scar. Patients with a personal history of rheumatic diseases, collagen diseases or "autoimmune" diseases, cannot safely use injectable collagen. Patients are always tested on the forearm and observed prior to treatment, to ensure that they are not allergic to the collagen. Improvement is immediate but is not permanent. Continuous retreatment is required. New research may develop more permanent substances to inject into scars.
Punch Grafts Punch grafts are small pieces of normal skin used to replace scarred skin. A tiny instrument is used to punch a hole in the skin and remove the scar. The area is then filled in with a matching piece of unscarred skin, usually taken from the back of the earlobe. The "plugs" are taped into place for five to seven days as they heal. Even though the punch grafts form scars of their own, they provide a smooth skin surface which is far less visible than depressed scars. This is the best treatment for deep acne scars.
Chemical peels remove the top layer of the skin with a chemical in order to smooth depressed scars and give the skin a more even color. This technique is helpful for superficial scars, and is often used to treat sun-damaged, or irregularly colored skin. The chemical is applied to the skin with an ordinary cotton-tipped applicator beginning on the forehead and moving over the cheeks to the chin. Different chemicals can be used for different depth peels. Light peels require no healing time while deeper peels can require up to two weeks to heal. The amount of scarring and color change determines the type of peel selected.
Further Scar Treatment Methods
Cryosurgery involves freezing of the upper skin layers which causes blistering of the skin. This can sometimes cause scars to diminish in size. This technique is used on raised acne scars.
Result of a combination of surgical elevation of chicken pox dermabrasions.
Cortisone injections are effective in softening very firm scars (or keloids) causing them to shrink and flatten.
Cosmetics applied correctly can be very good at covering up scars. Physicians encourage patients to wear make-up after scar treatments. Make-up will improve the appearance while nature completes the healing process.
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